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With 4 week old and with many questions!

Long Post Warning...

Hi Everyone,

I have been reading this forum for a week or two now and it has helped me in many ways while I'm figuring out this breast feeding journey with my bub. However, it's time for me to speak up and get my questions answered. TIA for your help.

A little background: My 4 week old is gaining weight and has good diaper output. During the day he goes 1.5-2.5 hours between nursing sessions, but at night time it's more like 1.5-2 hours. He's still got his nights mixed up with the days!

About me: I have a flat nipple which is on my R side and my L side is pretty normal.

Questions:

Do I have OALD/OS?
I think I have some of the symptoms - baby is choking on both breasts after the first let-down, baby is gassy from gulping so fast, baby spits up a lot and doesn't like to be laid flat because he's so gassy and uncomfortable. However, we don't have green stools, although they are quite watery and gassy/explosive. My breasts aren't leaking too bad or feeling too engorged these days.

I have been nursing lying-down and laid-back and have felt that these are helpful in controlling the flow.

So last week I decided to try block feeding and did so until yesterday. If he fed from the R breast on the 1st feed, I would offer the R one more time. However, the 2nd time, he wasn't as interested and would shake his head and release the nipple after some time. Does that mean that there isn't enough flow to say that I have OS? Or does it just mean that he doesn't prefer the slower flow afterwards and wants the fast flow like he's used to? He often tugs and pulls at the nipple which hurts!

I didn't notice much of a difference in the OS symptoms after this week of block feeding so I decided to stop. However, now he likes to shake his head and pull at the nipple still.... at the end of the feed. Sort of like he's frustrated with the flow. I have tried compressions at those seem to help but just for the short time that I am compressing.

Is he wanting more milk and I should switch breasts at this point? Is he going through a growth spurt? For the last three weeks he has gained over 500g each time he was weighed! So he's a healthy boy. I just want to clarify if I have OS/OALD.

I am willing to go back to block feeding twice on each breast if that will help with the gassiness, choking, and general uncomfortable feeling he goes has to deal with.
Also someone suggested the having him sleep on an incline would help. Any advice on this? Finally, we have tried carrying him around in a moby wrap and swaddling him at night. I think he's getting used to the moby but really squirms when swaddled.

What else can we do to help him? We are trying everything we can think of and are willing to try more!

Re: With 4 week old and with many questi

Welcome!

Based on what you have posted, it sounds like you probably do have some sort of oversupply/fast letdown issue. The choking, the explosive and watery poops, the gassiness, the spit-up, the feeling of engorgement, that all points to some level of OS/OALD. But how bad a level? That's the tough part to figure out!

Managing OS/OALD is an art, not a science. I would keep block feeding, but with caution, because it is possible to go too far and reduce your supply to a level which is too low. Watch the baby's diaper output carefully. Be flexible. If your baby seems to need more milk, even after a good long time on the first breast, don't be afraid to switch him to the second side. You may want to block feed only part of the day- many moms have too much milk in the morning and just enough in the evening.

Is there any particular time of day when your baby seems particularly fussy or uncomfortable?

Re: With 4 week old and with many questi

Do I have OALD/OS?
I think I have some of the symptoms - baby is choking on both breasts after the first let-down, baby is gassy from gulping so fast, baby spits up a lot and doesn't like to be laid flat because he's so gassy and uncomfortable. However, we don't have green stools, although they are quite watery and gassy/explosive. My breasts aren't leaking too bad or feeling too engorged these days.

I would say it is certainly possible you have some, likely mild OALD. But is that really a problem? It may get worse in the coming weeks, or it could just as likely go away all together on its own, as your milk supply regulates & your baby grows and becomes more able to handle the flow. It is common for mothers to have what basically amounts to a temporary case of oversupply between *about* 2 weeks and 6 weeks, because this is when your milk supply really ramps up. Once your body figures out how much milk your baby needs, it levels off, and in fact your daily milk volume from about now until you introduce solids will stay the same, (although the milk will change in makeup) which is all just perfect for your growing baby.

The thing to remember about oversupply and overactive letdown is that this is not a problem unless it is a PROBLEM. Don't get hung up on foremilk v hindmilk concerns, all of your milk is good for your baby, and any 'imbalance' is only a problem if it is causing discomfort. And is it? Many babies whose moms do not have OALD have similar 'symptoms." As you note, your baby is gaining well and is healthy. A 4 week old baby who wants to nurse very often (day and night,) spits up frequently, has gas, or objects to being laid down does not necessarily indicate any problem. It could be OALD, sure, or it could all be normal young baby behavior. If baby is choking during initial letdown, that is a problem if it creates an aversion to nursing, or causes baby to clamp down on you (yowie) but in any case, it may be helped quite a bit by allowing that first rush to go into a handy towel & then relatching baby, and/or, by nursing uphill. (As you have found, laid back breastfeeding positions work great for this.)

Block nursing is a technique to reduce milk supply, and imo should only be used by mothers who are pretty certain that they really have oversupply and that the oversupply issues cannot be improved by less invasive ways of dealing with it. Overactive letdown and oversupply are two different things-they usually happen together, but one can have oald without oversupply, or, as I mentioned above, only temporary oversupply. So I alwasy preach caution when mucking about with ones milk supply in such early days, unless, of course, the overactive letdown is keeping baby from being happy at the breast and/or causing extreme discomfort in baby. On the other hand, I doubt you have done any harm to your milk supply with the mild block feeding you were doing.

As far as what is going on now, I have seen reports that babies whose moms had early OALD can get a tad fussy when moms milk supply regulates, and the fact that you no longer feel engorged would point to that regulating happening, as it naturally would around this time. My understanding is, this is usually temporary until baby figures it out. Pulling and clamping at the breast are also signs of OALD, or can mean nothing any number of things. As long as baby continues to nurse frequently and gain well, I would not worry about it.

Frequent feedings & letting baby "finish the first breast first" at each feeding (some babies will only want to nurse one side per feeding and that is just fine) may take care of this fine given a bit of time. As Mommal says, if you feel that block feeding will help, just proceed with caution.

You also expressed concerns about how frequently your baby is nursing, and baby not wanting to be laid down to sleep.

For getting baby to take to lying down on his own, you could try nursing baby to sleep and try holding baby in a more or less upright position for about 20- 30 minutes after feeding and he may take to being laid down better. Your moby may be a great help with this. But as I am sure many moms here can attest, many babies sleep best on the warm chest & in the warm arms of a trusted caregiver.

Swaddling is designed to convince a baby he is being held, and thus to make a baby sleep longer. Since your baby is gaining well, the sleeping longer is not a health issue for him (as it would be for a slow gaining baby.) However, a longer duration between feedings would tend to make OALD worse. So, since swaddling is not really working anyway, you can ditch that if you like.

Your babies sleep behavior is normal. Very young babies have to eat very frequently and so they do not sleep for long periods. This is normal. If it is causing you to not get enough sleep and affecting your ability to function, you may want to try alternative sleeping arrangements and/or embrace napping.

You mentioned your 'flat' nipple. This is not an issue unless baby cannot latch or nursing is not comfortable for you. Is nursing comfortable for you? This is very important. If it is not, let us know.

Re: With 4 week old and with many questi

It's very possible (and pretty common) to have OALD without oversupply. So your letdowns may be strong, but you may not need to block feed. (By the way, giving one breast per feed is a mild form of blockfeeding that works great for lots of moms. You don't have to offer the same breast twice to be "blockfeeding" - you can offer the other side at the next feed and that's still going to tame oversupply a little bit.) I agree with Mommal - go slowly and cautiously with blockfeeding. Trust your gut. If your baby seems hungry, switch sides! From what you're saying here, I'm guessing that you have OALD, but only very mild oversupply. Offering one side at a time might strike the balance you need.

ETA: OALD is hard in the early months, but babies tend to grow into it (and your breasts tend to get less enthusiastic over time ). So even if you did NOTHING about it, it would get better. It can make nursing sessions a little harder, but it's really not a "problem" per se for most moms and babies.

You can call me JoMo!

Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.

Re: With 4 week old and with many questi

Originally Posted by @llli*mommal

Welcome!

Managing OS/OALD is an art, not a science. I would keep block feeding, but with caution, because it is possible to go too far and reduce your supply to a level which is too low. Watch the baby's diaper output carefully. Be flexible. If your baby seems to need more milk, even after a good long time on the first breast, don't be afraid to switch him to the second side. You may want to block feed only part of the day- many moms have too much milk in the morning and just enough in the evening.

Is there any particular time of day when your baby seems particularly fussy or uncomfortable?

I had no idea you could block feed just part of the day. I will try that, but I think you're right, I must just have OALD with a slight oversupply. I haven't tried pumping to see what my output is. But my instinct says to keep just giving one breast at each feed and see how that goes. Some times I know he wants the other breast and other times he doesn't finish. So it's just all over the place really. He really has no set feeding pattern even at 5.5 weeks. Is that normal?

My baby is more fussy from 2-7am. I don't know if that's just a response to the fact that I'm more irritable and he's feeding off my energy at night or if there's something going on at that time like wind. Last night he was feeding every hour after 2am! That continued until 10am. Because of his age I'm hoping it's a growth spurt.

And in response to the other posts: I have read the LLL book while I was pregnant. I should borrow it again as it has so much information that will be useful now that I have an actual baby.

Oh and my flat nipple.... It's quite uncomfortable for the first minute or so and then the "twinging" subsides and it's not as pleasant as the L side but tolerable. I was told that this twinging feeling is the tissue stretching and to continue to expect it so long as I am BFing.

Also, I feel that he latches on properly and after the breast becomes softer, he slips off. Is this because the nipple is not far back enough in his mouth or is it because of the nipple becoming flat again? It's really difficult to get him to open his mouth wide on that side after the initial latch. It's like he knows which side he's on and opens his mouth differently for each side!

Lastly, sometimes on the R side he will pull at the nipple, almost in frustration, a while into the session (almost towards the end) and I thought maybe it's because the supply was low on that side. But after he releases, I can still squeeze what I think is plenty of milk. So could a potential poor latch cause insufficient sucking on his part and therefore be dwindling my supply on that side? I don't want to be lopsided so I offer that side often, but it still seems like my L side is much larger than my R. Any thoughts?

Re: With 4 week old and with many questi

Totally normal for a 5.5 week old baby to not have much of a routine yet. If you're waiting for that magic moment when your baby all of a sudden settles into an every-3-hours nursing routine, you may have to wait for a long time. Breastfed babies often like to nurse every hour or two or even more frequently, particularly during the day. And there's nothing wrong with that: frequent "snacking" is a totally normal feeding pattern and is also a healthy one. And since breastfed babies associate the breast with comfort, when they want a cuddle from mom they often also want to nurse.

The 2-7 am fussiness could be due to faster flow at night- many moms have the most milk in the wee hours of the morning, since prolactin levels peak overnight. It could also be position: if you are feeding in a different position during that time it could be bugging the baby.

Regarding that "twanging" feeling- I don't think you're likely to be putting up with that forever. A lot of moms with small babies experience the "30 second sizzle" when their baby first latches on. The pain, or sizzle, is the feeling of the nipple starting out too shallow in the baby's mouth, and then being sucked deeper into the mouth, into the ideal position under the soft palate. But this is usually a temporary problem, something that disappears as the baby grows and is able to latch on perfectly every single time.

Small babies often lose their latch as a feeding progresses. It is tiring to nurse- imagine if you had to hold onto a water balloon bigger than your head using just gums, tongue, and lips! You may want to try propping your breast up as you nurse, using either your hand or a rolled-up washcloth. That can keep baby from getting tired out. Experimenting with different positions may also help.

A poor latch at the end of the feeding is generally not as big a problem as a poor latch that lasts throughout the feeding. I don't think you need to worry about your baby pulling at the right-side nipple at the end of feedings. It may be his way of stopping a flow of milk when he's done eating, or it could be his way of trying to get more milk to let down. It's totally normal to be somewhat lopsided- humans are not perfectly symmetrical! But if lopsidedness is troubling you, I suggest checking out this link: http://www.kellymom.com/bf/concerns/mom/lopsided.html

Re: With 4 week old and with many questi

I completely agree that you are unlikely to feel that "twinge" the whole time you are breastfeeding. Older babies take the nipple more deeply into their (larger) mouths and it should feel like a perfect latch from the get-go. My flatter nipple also got stretched to the point where it's really not flatter anymore at all. It protrudes as much as the other nipple (and they are both more "outies" now than they were bf I got pregnant).

You can call me JoMo!

Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.